Latest / Morning Medical with Dr. Chow / GLP-1 Drug Concerns, Zepbound for Sleep Apnea, and Heatwave Safety

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GLP-1 Drug Concerns, Zepbound for Sleep Apnea, and Heatwave Safety · Morning Medical with Dr. Chow

• 0:00
  Welcome to Morning Medical with Dr.
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  Chow, your go-to podcast for the latest in medical and health news from around the world.
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  I'm your host, Dr.
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  Chi-Ming Chow.
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  Each day, we delve into the most pressing health topics, bringing you insights and
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  updates that matter.
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  Today, we're diving into a pressing issue in the realm of psychiatry and eating disorders:
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  the misuse of GLP-1 drugs by individuals with eating disorders.
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  This topic is gaining attention due to its potential implications on health and safety.
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  In a recent interim analysis of an ongoing cross-sectional study, researchers found that
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  among over 400 people with eating disorders, 32.1 percent reported having used GLP-1 drugs,
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  and 22 percent reported current use.
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  Alarmingly, 10 percent admitted to misusing these medications, and nearly 10 percent were
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  using noncommercial compounded products.
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  This data was shared by Nicholas C.
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  Peiper and his co-authors in a research letter published in JAMA Psychiatry.
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  GLP-1, or glucagon-like peptide-1 receptor agonists, are primarily indicated for the
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  treatment of type 2 diabetes, obesity, and cardiovascular risk reduction.
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  Recently, their use has expanded to include treatment for chronic kidney disease and severe
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  obstructive sleep apnea.
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  However, there are no indications for the use of GLP-1 drugs in treating any eating
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  disorders, even those with higher cardiometabolic comorbidities such as binge
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  eating disorder or atypical anorexia nervosa.
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  Sahib Khalsa, a doctor from the David Geffen School of Medicine at the University of
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  California, Los Angeles, who was not involved in the study, noted that if the data from this
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  sample are nationally representative, it suggests that the rates of GLP-1 drug use among
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  those with eating disorders could be double that of the general adult population, which
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  stands at 15 percent.
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  This is indeed concerning, and it highlights the need for general practitioners to assess
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  patients for potential eating disorders and refer them to appropriate mental health
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  professionals or dietitians.
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  The study also points out the challenges faced by individuals with eating disorders as they
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  navigate a rapidly evolving environment of compounded GLP-1 receptor agonists, which can
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  be easily obtained without medical or regulatory oversight.
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  This calls for urgent pharmacovigilance as the market continues to expand with new products
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  and formulations.
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  Interestingly, the prevalence of GLP-1 drug use varied among different eating disorder
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  subtypes.
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  It was lowest among those with anorexia nervosa at just over 10 percent, and highest among
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  those with atypical anorexia nervosa and binge eating disorder, exceeding 40 and 50 percent,
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  respectively.
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  Understanding the reasons for this variability and its potential harms is crucial.
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  It's important to note that the study has its limitations, including its cross-sectional
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  design, nonprobability sampling, and reliance on self-reporting.
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  Follow-up studies are needed to provide more precise estimates among eating disorder
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  subtypes, evaluate demographic differences, and examine key correlates such as patterns of
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  misuse, sources of acquisition, reasons for use, off-label use, and marketing exposures.
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  In a significant development for those battling severe obstructive sleep apnea, Health Canada
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  has approved the use of a weight-loss drug called Zepbound.
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  This drug is particularly aimed at adults struggling with obesity who are also dealing
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  with obstructive sleep apnea, a condition where the upper airway becomes blocked during sleep,
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  leading to temporary pauses in breathing.
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  Obstructive sleep apnea is often associated with obesity, and its symptoms can include
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  daytime sleepiness, high blood pressure, and increased risks of heart attacks and strokes.
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  Zepbound, developed by Eli Lilly, contains the active ingredient tirzepatide.
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  This compound acts on both glucagon-like peptide-1 and glucose-dependent insulinotropic
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  polypeptide hormone receptors to reduce appetite and, consequently, lead to weight
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  loss.
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  Tirzepatide is also found in Eli Lilly's diabetes drug Mounjaro, and it competes with
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  Novo Nordisk's semaglutide drugs, like Ozempic and Wegovy, on the market.
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  According to Health Canada spokesperson Marie-Pier Burelle, Zepbound should be
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  administered via injection once a week and is intended to be used in conjunction with a
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  reduced-calorie diet and increased physical activity.
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  It is important to note that Zepbound is not meant to replace continuous positive airway
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  pressure, or CPAP, therapy, which remains the first-line treatment for moderate to severe
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  sleep apnea.
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  Patients are advised to continue using their CPAP machines unless instructed otherwise by
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  their healthcare provider.
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  The approval of Zepbound follows promising Phase 3 clinical trials.
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  In these studies, patients with both obesity and sleep apnea who were not using CPAP
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  machines experienced a significant reduction in breathing interruptions per hour—25 fewer
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  episodes compared to those on a placebo.
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  For patients using CPAP machines, the reduction was even more pronounced, with 29 fewer
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  interruptions per hour.
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  Dr.
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  Mandeep Singh, a clinician investigator in sleep science, highlighted that the severity of
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  sleep apnea is determined by the number of breathing interruptions per hour of sleep.
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  A reduction of 25 to 29 events per hour could move a patient from the severe category to a
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  lower-severity category, which is a substantial improvement.
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  While there is anecdotal evidence suggesting that weight loss from other glucagon-like
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  peptide-1 drugs may benefit people with sleep apnea, more research is needed to understand
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  the direct effects of these medications on the upper airway, especially in patients without
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  obesity.
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  As with any medication, there are potential side effects.
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  The most common for glucagon-like peptide-1 drugs like tirzepatide are nausea, vomiting,
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  diarrhea, and constipation.
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  Less common but more serious side effects can include inflammation of the pancreas, bowel
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  obstruction, and gallstones.
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  Therefore, it's crucial for healthcare providers to discuss the risks and benefits of
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  Zepbound with patients diagnosed with obstructive sleep apnea.
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  As temperatures soar to record levels, keeping children safe during a heatwave is a pressing
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  concern for many parents and caregivers.
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  With their smaller body mass and developing systems, children are particularly vulnerable
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  to the effects of high temperatures.
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  Here are some key strategies to ensure their safety and well-being during these sweltering
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  days.
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  First and foremost, hydration is critical.
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  Children should be encouraged to drink plenty of water throughout the day, even if they do
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  not feel thirsty.
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  Avoid sugary drinks and caffeine, as these can contribute to dehydration.
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  Make sure to have water readily available, especially during outdoor activities.
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  Clothing choices can also make a significant difference.
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  Dress children in lightweight, loose-fitting clothing made of breathable fabrics like
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  cotton.
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  Light-colored clothes reflect the sun's rays, helping to keep body temperatures down.
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  Additionally, a wide-brimmed hat can provide necessary shade and protection from the sun.
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  Try to schedule outdoor play and activities for the cooler parts of the day, such as early
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  morning or late afternoon, when the sun is not as intense.
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  During peak heat hours, ideally between 11 a.m.
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  and 3 p.m., keep children indoors or in shaded areas to minimize exposure to the sun.
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  It's also vital to keep an eye out for signs of heat-related illnesses, which can escalate
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  quickly in children.
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  Symptoms such as excessive sweating, weakness, dizziness, headache, and nausea should be taken
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  seriously.
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  If any of these symptoms occur, immediately move the child to a cooler environment, provide
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  water, and seek medical attention if necessary.
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  For families with access to air conditioning, ensure that it is used during the hottest parts
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  of the day to provide a cool refuge.
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  If air conditioning is not available, consider visiting public places like libraries, shopping
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  malls, or community centers that are air-conditioned.
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  Fans can help, but they are not as effective as air conditioning in extreme heat.
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  Finally, never leave children unattended in a parked car, even for a short period.
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  The temperature inside a vehicle can rise rapidly, reaching dangerous levels in just a
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  few minutes, posing a serious risk of heatstroke.
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  By following these precautions, we can help ensure that children remain safe and healthy
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  during heatwaves.
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  Staying informed about weather forecasts and heat advisories will also allow for better
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  planning and preparation.
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  As our climate continues to shift and heatwaves become more frequent, understanding how
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  different groups are affected by hot weather is crucial.
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  Today, we're exploring why women are more affected by hot weather than men.
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  This topic has garnered attention as researchers and health professionals seek to
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  address gender-specific health vulnerabilities in the face of climate change.
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  Studies suggest that there are several physiological and biological factors
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  contributing to women's increased susceptibility to heat.
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  One key factor is body composition.
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  On average, women tend to have a higher percentage of body fat compared to men.
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  This can impact heat dissipation, as fat acts as an insulator, making it harder for the body
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  to cool down efficiently during high temperatures.
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  Hormonal differences also play a significant role.
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  The female hormone estrogen can affect the body's ability to regulate temperature.
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  During certain phases of the menstrual cycle, women may experience changes in body
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  temperature regulation, which can make them more sensitive to heat.
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  Additionally, menopausal women often experience hot flashes, which can exacerbate the effects
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  of high temperatures.
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  It's also important to consider societal and occupational factors.
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  Women are more likely to work in roles that involve caregiving or domestic duties, which
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  can limit their ability to escape heat.
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  For instance, staying indoors to care for children or elderly family members can increase
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  exposure to indoor heat, especially in areas without adequate cooling solutions.
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  Furthermore, women are often less represented in outdoor manual labor, which means they may
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  not be as acclimated to high temperatures as men who work outdoors regularly.
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  This lack of acclimatization can contribute to a higher risk of heat-related illnesses when
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  they are exposed to extreme heat conditions unexpectedly.
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  Addressing these disparities requires a multi-faceted approach.
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  Public health strategies should include gender-specific guidelines for heatwave
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  preparedness and response.
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  Ensuring access to cooling centers, promoting heat health awareness, and tailoring advice to
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  meet the unique needs of women can help mitigate the impact of hot weather.
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  As we wrap up today's episode of Morning Medical with Dr.
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  Chow, I hope we've shed some light on the complexities of how heat affects women
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  differently than men.
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  Understanding these nuances is vital in adapting to our changing climate and ensuring
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  everyone's health and safety.
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  Thank you for joining me today.
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  Stay cool and stay informed.
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  Until next time, take care.